What is LIC 602A Form?

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The LIC 602A form  is a Physician’s Report for Residential Care Facilities for the Elderly (RCFE) in California. It determines if an individual is medically fit for assisted living. Required by the California Department of Social Services (CDSS), it ensures proper care levels for residents.

Checklist for LIC 602A (Physician’s Report)

• Personal Info – Name, DOB, address, emergency contact
• Medical History – Current conditions, past illnesses/surgeries
• Medications – List of all meds & allergies
• Daily Living – Can they walk, eat, dress, and bathe on their own?
• Cognitive/Mental Health – Memory issues? Mental health concerns?
• Tests & Vaccines – TB test, recent vaccines
• Special Needs – Diet restrictions, special care needs
• Doctor Info – Primary doctor, any specialists, legal documents (if any)
• Legal Documents (if any) – Advance Directive, Durable Power of Attorney, POLST

Why is the 602A Form Important?

• Medical Assessment: Evaluates health, mobility, cognition, and medication needs.
• Legal Requirement: Facilities need it for state licensing compliance.
• Care Planning: Helps tailor services like memory care and ADL assistance.
• Risk Management: Documents fall history, medication side effects, and chronic conditions.

Where to Get the 602A Form

• Physician’s office
• Assisted living facilities
• Online via CDSS: Download Here

Who Completes the 602A Form?

A licensed healthcare provider, including:

• Physicians (MD/DO)
• Nurse Practitioners (NPs)
• Physician Assistants (PAs)

Information Included:

• Diagnosis & Prognosis: Chronic conditions and recent hospitalizations.
• Functional & Cognitive Status: ADL abilities, dementia, and decision-making capacity.
• Medication Management: Prescription, Over the Counter (OTC) medications, interactions, and assistance needs.

When to Complete It?

• Before move-in to assisted living.
• If health status changes significantly.
• Every 90 days, if required by the facility. Most request to renew it every 12 months.

602A Form Validity & Updates

• Valid for 90 days from completion.
• Needs an update if health deteriorates, mobility changes, or form expires before move-in.

Other Required Assisted Living Documents

1. 602A Physician’s Report – Confirms medical eligibility.
2. Resident Agreement – Details services and costs.
3. Power of Attorney – Assigns healthcare and financial decision-making.
4. Insurance Information – Ensures financial arrangements.
5. Advance Directives – Specifies life-sustaining treatment preferences.
6. Medication List – Helps caregivers manage prescriptions.

Additional Physician Notes:

• Dietary restrictions
• Fall prevention plans
• Disability accommodations

Here are some additional sources and references for the LIC 602A Form in California:

1. California Department of Social Services (CDSS) – RCFE Physician’s Report (602A Form)
   https://www.cdss.ca.gov
2. California Assisted Living Association (CALA) – Assisted Living Requirements
   https://www.caassistedliving.org
3. California Department of Public Health (CDPH) – Licensing & Certification
   https://www.cdph.ca.gov
4. A Place for Mom – Assisted Living Paperwork Guide
   https://www.aplaceformom.com/assisted-living
5. California Health & Human Services Agency (CHHS) – Senior Care Resources
   https://www.chhs.ca.gov